APPROACHES TO WORKING WITH

THE POPULATION GROUPS

VII
Dixie
Ela Mulyana
Ricka Ayu Virga Ningrum
Rifai Ali
Satyawira Aryawan Deng
Shelly
Ulfa Oktaviani
Overview
- Address health issue for targeting intervention towards specific
groups such as black, asian, minority ethnic, young people,older
people, refugees and asyllum seekers.
- Create more flexible and responsive services towards the health risk
of particular groups.
- Improve the opportunities or strengthen the targetting communities
by effective health intervention.
- Ilustrate a range of health promoting or helath developing activities
for the older people, children, BAME, refugees and sylum seeker.
Introduction
• The establihment of NHS in the UK as a universal service for everyone with
high quality care and relatively low cost as one of great achievement in 20th
century.
• Many debate around whereby certain geographical areas provide better
service and manage to recruit and retain staff more easily.
• Reflects the socio-economic with poorer areas receiving poorer service.
• Many commentators argued that NHS perpetuates sexist, ageist, and racist
stereotypes and fails to adequately meet the needs of particular
population.
• In order to meet the needs of specific marginalized, ‘harder to reach’
groups, targetting has been suggested as an appropriate starategy.
Approach to Working With Population Groups

Targeting risk groups can seem an attractive proposition.

Resources may be directed towards groups with the
highest level of health needs, which should prove effective
and equitable. As discussed in Foundations for Health
Promotion (Naidoo and Wills 2009)
needs assessment is intended to look at unmet needs for
services and to provide information that will allow services
to be tailored to local populations.

Target groups can be distinguished in two ways:

geographical groups bound together by locality
social groups bound together by some other attribute, such
as age.

Within any target group such as older people (65 or

more years of age) there are some people who have
more needs than others, for example:

•those over 80 years of age (mainly women)

•those who live on their own
•those who belong to ethnic minority groups.
This chapter considers four different population groups
older people, children, Black, Asian and minority ethnic
groups, and refugees and asylum seekers in detail. For
each population group, their specific health needs are
outlined, followed by examples of different kinds of
strategies and interventions targeted at the group to
meet their needs.
 Older People
• The developed world talks of a demographic time bomb in the twenty-
first century. The UK census of 2001 revealed that for the first time there
are more people aged over 60 than there are under 16. People aged over
60 have risen from 16% of the whole of the population in 1951 to 19% in
2007. There are also 2.7 million people aged over 80. This poses major
problems for the care and costs to the state of supporting an ageing
population. Reducing mortality and increasing life expectancy is also not
seen as an unmitigated public health success. The quality of life is also
important. Although chronological age is not synonymous with disease
and ill health, nevertheless there is an increase in frailty, chronic illness
and greater use of health and social care services with increasing age.
Inequalities in health: older people
• Older people are more likely to live in poverty, in poorer and older
accommodation and as such are at risk of fuel poverty and accidents.
• Access to transport is difficult, which limits access to goods and
services and social contacts, which is reflected in a decline in
psychosocial health in some older people, especially widows.
• Poverty in older people particularly affects women as there are 3
times as many women as men aged 85 and over and most of these
live alone – only 38% of older women live with a partner/husband.
The health of older people does decline with age although there may be
little association between chronology and physiological age. Degenerative
conditions such as weaker muscles, loss of flexibility in joints, poor vision
and hearing and loss of cognitive function may occur in the ‘young old’ of
60–70 or the ‘old old’ of 85 plus or not at all. Health problems tend to be
related to a number of limited diseases for which the risk factors are well
known – coronary heart disease (CHD) and stroke, cancers, respiratory
illness and osteoporosis. Dementia affects 1 in 5 people over 85 although
its severity varies. Although it is clear that as men and women reach very
late life their activities become more circumscribed, in earlier late life
their mobility and task capacity are unimpaired and they are well able to
be involved beyond their home and household, in work, care giving, sport
and recreations.
• Standard 8 of the UK National Service Framework for Older People aims to
‘extend the healthy life expectancy of older people’. For most older people this
means their independence, autonomy and maintaining their functional capacity.
Yet disability as measured in relation to activities of daily life tends to rise in
those over 70 and is mostly related to locomotor function. Nearly two-thirds of
people aged over 65 cannot walk 200 yards without stopping or climb a flight of
12 stairs (DH 2007a). Falls and fractures are associated with high morbidity,
mortality and substantial costs. In 1999, there were over 3000 deaths and over
85,000 serious injuries as a result of falls in older people (DH 2001).
• Encouraging older people to remain physically active is a major priority. This
means action in broader areas – ensuring the maintenance of pavements, better
lighting in streets and parks, restricting traffic in residential and shopping areas,
and improving town centres, as well as developing affordable and accessible
public transport through concessionary fares and mobility buses and tackling
community safety so that older people feel safe in public areas
Children
• Children are therefore identified as a population group having specific
health needs that should be targeted.
• A Health Survey for England that focused on young people found that
just over 25% of boys and just under 25% of girls aged 2–15 years
reported a long-standing illness, with 10% indicating that it limited
their activities in some way (Prescott-Clarke and Primatesta 1998).
• There are two arguments that show it is important to focus on
children in social policy interventions:
1. the biological rationale
2. the social rationale.
• Wadsworth and Butterworth (2006) have analysed birth cohorts
and shown that family circumstances influence later health
status
• One element of policy interventions focus on the protective
factors for childhood – optimizing growth before birth and early
education interventions.
• Effective interventions are providing social and emotional support;
early detection of postnatal depression; policies to increase the
initiation and maintenance of breastfeeding; policies which
improve the health and nutrition of women of childbearing age
and their children; and preschool education
• The United Kingdom, a welfare food scheme has been in place
since 1940, originally providing cod liver oil and orange juice.
• Sure Start is a programme that was targeted at preschool
children and their families initially in disadvantaged areas of
England, and Children’s Centres are being rolled out to every
community.
• Early intervention programmes provide education,
• care and improved nutrition. Supporting
• educa tion and tackling ‘the poverty of expectation’ is a
• major plank of UK policy.
Black, Asian and Minority Ethnic Groups
Ethnic minority disadvantage cuts across all aspects of deprivation.
Taken as a whole, ethnic minority groups are more likely than the rest
of the population to live in poor areas, be unemployed, have low
incomes, live in poor housing, have poor health, and be the victims of
crime.

• BAME groups are an attempt to move away from the medicalized

concept of ‘race’ reffrering to biological and physical differences
between human groups, such as skin colour.
• The concept of BAME groups prioritizes nations of culture rather than
bilogical characteristics.
 Separate interventions targeting BAME groups inevitably risks marginalizing
minority ethnic issues. It also implies that the health problems in minority
ethnic groups are different from those in the ethnic majority, with different
causes and different solutions, whereas in fact the similarities are greater than
the differences.
One way of ensuring that the needs of BAME groups are integral to programme
planning and policy making is to ensure that minority ethnic groups are
represented, consulted and involted groups, their visibility can help to reduce
the sense of exclusion.
 Refugees and asylum seekers

The UN convention of 1951 defines a ‘refugee’ as someone who

‘owing to a well founded fear of being persecuted for reasons of
race, religion, nationality, membership of a social group, or
political opinion is outside the country of his nationality and is
unable, or owing to such fear, is unwilling to avail himself of the
protection of that country; or who, not having a nationality and
being outside the country of his former habitual residence, as a
result of such events is unable to or owing to such fear, is
unwilling to return to it’.
Basic information on many areas have
produced information packs for
practitioners working with refugees :

• understanding refugee support needs

• exile and identity
• cultural differences
• communication in health care
• issues of women
• working with survivors of torture and rape.
There are three broad categories of interventions used to improve
communication (Sanders 2000):

1. A linguistic model
2. professional-centred model
3. A client-centred or advocacy model that
focuses on the client
Conclusion
a scientific notion of risk
Targeting health promotion at
specific population groups
an ethical notion of equity
an economic notion of
costeffectiveness.
problematic in practice
focusing on biological, genetic or lifestyle
factors that have less impact on health status
than basic structural factors such as
education and income
Certain marginalized groups in society have
both high levels of health needs and low
access to services. In order to provide an equal
service for all, such groups need specific
targeted services to enable them to have the
same access as the general population
Providing additional resources to proactively
meet the health needs of marginalized groups
is likely to be far more cost-effective than
waiting to meet the costs of a range of health
and social needs resulting from increased
marginalization and corresponding ill health
and social exclusion.
Thank you